Nutrition Intervention In Patients With Protein-energy Wasting On Maintenance Hemodialysis

ObjectiveThe aim of this study was to investigate the prevalence of protein-energy wasting(PEW) in maintenance hemodialysis (MHD) patients and evaluate the effects ofnutritional support on nutrition status of MHD patients with protein-energy wasting.MethodsIn this prospective, randomized and controlled study, first of all,150maintenance hemodialysis patients, who were treated in the blood purification centreof the hospital were enrolled to investigate the prevalence of PEW by using thediagnosis criteria of PEW recommended by International Society of Renal Nutritionand Metabolism from January to December2013. After that,39patients, whoconformed to the diagnosis criteria of PEW and were self feeding, were randomlydivided into three groups:(1).oral enteral nutrition group (13cases);(2).fat emulsiongroups during hemodialysis (13cases);(3).the normal diet group (13cases),and weretreated with nutrition intervention respectively. In the meanwhile, biochemicalindexes and the anthropometry parameters of patients were tested before and afterintervention treatment, including albumin, prealbumin, transferring, C reactive protein,blood lipid, body weight, waist circumference, hip circumference, triceps skin foldthickness, mid-arm muscle circumference, grip strength and so on. And all patientswere carried out the diet plan and nutrition education by clinical dietitians and chronickidney disease specialists.Results1.The occurrence rate of protein-energy wasting (PEW) in patients withmaintenance hemodialysis was38.5%.2.The effect of nutritional intervention on nutrition condition in patients with maintenance hemodialysis.2.1Before and after the intervention, serum level of albumin(ALB), prealbumin(PA), transferrin(TRF) in the oral group and the fat emulsion group were increasedsignificantly (P<0.05), while there was no significant difference in the controlgroup(P>0.05).2.2There was no significant difference of serum levels of ALB,PA and TRFamong these groups(P>0.05).2.3There was no significant difference of serum level of hemoglobin(Hb) in thethree groups before and after treatment(P>0.05), and showing the same among thesegroups also(P>0.05)3.The effect of nutrition intervention on inflammation condition, immunefunction in maintenance hemodialysis patients.There was no significant difference in white blood cell count, neutrophil count,serum level of C reactive protein(CRP) and lymphocyte count among the three groupsbefore and after treatment(P>0.05).4.The effect of nutrition intervention on lipid levels in patients with maintenancehemodialysis.Significant difference was not observed in the levels of triglyceride(TG),totalcholesterol (TC), high density lipoprotein (HDL),very low density lipoprotein(VLDL),Low density lipoprotein(LDL)in the three groups before and after treatment(P>0.05), and showing the same among these groups also(P>0.05).5.The effect of nutrition intervention on anthropometry parameters in MHDpatients.Before and after the intervention, body weight, body mass index (BMI), mid-armcircumference (MAC), mid-arm muscle circumference and grip strength in the oralgroup and the fat emulsion group was increased significantly (P<0.05), but there wasno significant difference in the control group (P>0.05). And significant difference wasnot observed in body weight, BMI, MAC, mid-arm muscle circumference and gripstrength of these groups (P>0.05). For waist circumference, hip circumference, triceps skin fold thickness (TSF), calf circumference among the three groups, there also wasno significant difference before and after treatment (P>0.05), and showing the sameamong these groups (P>0.05).Conclutions1. The occurrence rate in patients with maintenance hemodialysis was38.5%.2.The serum levels of ALB, PA, and TRF of patients were improved by oralnutrition and intravenous supplementation of fat emulsion.3.Oral nutrition and intravenous supplementation of fat emulsion could alsoimprove body weight, MAC, mid-arm muscle circumference and grip strength ofpatients.4.Oral nutrition and intravenous supplementation of fat emulsion did not influenceon inflammation condition,immune function,lipid concentration of patients.